The definition of mental health has far-reaching implications. Here in Aotearoa New Zealand, the promotion of mental health is a goal of many charities, ministries, and central government. But Professor Keller asks how you can pursue mental health without having a definition of what that is.
“We need to say what we mean when we apply the concept of health to the mind—and in doing so, why mental health matters.
“Research into the philosophy of mental health is important because people from different fields—economics, public policy, mental health, psychiatry—are confidently using definitions of mental health that, when you look closely, are inconsistent with one another. This has historically had dangerous consequences—for instance, at various times and places in history, women were considered mentally unhealthy for liking sex. Slaves, for wanting to be free.”
The definition of mental health needs a critical interrogation, says Professor Keller. “When you don’t have a defensible idea of what mental health is or what a mental disorder is, it is really easy to start pathologising a whole lot of things that turn out to be just reflections of prejudices.”
Philosophy is the ideal academic field from which to do this, says Professor Keller, because it examines the fundamental conceptual level and asks questions like ‘what do our words mean,’ using philosophical methods that have been used for thousands of years.
An issue he sees coming through now in various places is that when we talk about mental health and wellbeing, “we hold it up to totally unrealistic standards and tell people that if they don’t meet them, then they have a problem. We don’t have a shared understanding of clear standards of mental health. Media influencers and positive psychology experts can get away with anything”.
Professor Keller wants people to be aware of three things about the definition of mental health. “The first thing to notice is that health is a medical term. So, if we are going to talk about mental health, we also need to be prepared to talk about sickness, and cures, and treatments, and therapies.
“The second thing to realise is that it is subjective—to talk about mental health you need to be unashamed about the fact you are offering an evaluation of people’s way of thinking. You are in the domain of values, as well as of medicalisation—and it is always important to ask what values you are projecting on people when you say they are mentally healthy or not.”
This is particularly relevant when we consider different cultural values, says Professor Keller. “Here in Aotearoa, some Māori men diagnosed with schizophrenia have reinterpreted their symptoms by placing them within their own cultural worldview, understanding their ‘voices’ as connections with their ancestors.”
One definition of mental health frequently used is one developed by the World Health Organisation, likely in 1949, which states: ‘Mental health is a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.
Professor Keller says this reflects the assumption that what is going to save the world is hard work, and freeing up markets, and everybody being able to be productive. “It looks completely fine until you stop and wonder why, for example, being productive should be seen as such a central tenet of mental health.”
The third thing people should be aware of when talking about the meaning of mental health is that it is important to be humble. “Many past definitions of mental health now seem ridiculous. We need to accept that when we go down this road, we are doing our best, but we need to be open to correction.”
Professor Keller will apply findings from literature around the philosophy of disability and political philosophy to pursue a unified theoretical foundation for the concept of mental health.
He is currently seeking funding for a research project that will identify the assumptions we make about mental health in various academic and public fields and offer a new account of mental health. If successful, this funding will enable his research to have an impact beyond his discipline, through peer-reviewed articles and a book, and a conference.